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Leveraging Blockchain to Transform Clinical Credentialing
Session 280, February 14, 2019
Anthony D. Begando, CEO & Co-Founder
Professional Credentials Exchange
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Anthony D. Begando has no real or apparent conflicts of interest to
report.
Conflict of Interest
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Introduce Credentialing Generally and Discuss the Challenges
Facing the Healthcare Industry
Provide a brief overview of the ProCredEx platform and the
challenges addressed in its development
Review the current state of Blockchain / Distributed Ledger
Technology (DLT) and how it is utilized within the ProCredEx
architecture
Discuss the importance of scale within a marketplace application
Provide a brief demonstration of how ProCredEx transforms
credentials data collection and verification
Agenda
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Identify the intrinsic complexities existing within the clinical
credentials dataset
Recognize the contextual variations that exist between healthcare
organizations in interpreting credentials data and related artifacts
Explain how blockchain technology addresses gaps in trust
between transactional counterparties
Differentiate the various forms of blockchain protocols, permission
architectures, and consensus algorithms available for applications
seeking to leverage distributed ledger technology
Explain the importance of forming a minimum viable network in
developing blockchain-based solutions
Learning Objectives
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The process of gathering and verifying the data and artifacts
needed to confirm the professional competency of an individual to
perform a specific occupation within a specific setting
Applies to numerous industries:
Healthcare
Financial Services & Accounting
Aviation
Architecture & Engineering
Construction
Public Safety
What is Credentialing?
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Mandated, perpetual process confirming the
clinical competency of healthcare professionals
Must be performed by any organization
delivering or paying for patient care
Applies to virtually all 13.6 million care delivery
personnel
Physician / Hospital / Payer Use Case
o 4 - 6+ month process
o Costs $300 - $1,500+ / episode
o $7,500 daily net revenue forfeitures*
o 200MM+ annual artifact transactions
Payers spending $2.2BN annually to maintain
provider data
Challenges Facing Healthcare Credentialing
* Source: Merritt Hawkins 2016 Inpatient/Outpatient Revenue Survey
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Metric
Value
Number of Credentialed Physicians
600
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
Billable Days From Recruitment to Enrollment
107
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
Billable Days From Recruitment to Enrollment
107
Average Physician Daily Net Revenue
$7,500.00
Forfeited Net Revenue During Physician Onboarding
$802,500.00
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
Billable Days From Recruitment to Enrollment
107
Average Physician Daily Net Revenue
$7,500.00
Forfeited Net Revenue During Physician Onboarding
$802,500.00
Retroactive Payer Reimbursement Allowance (CMS,
Medicaid)
20%
Retroactive Payer Reimbursements
($160,500.00)
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
Billable Days From Recruitment to Enrollment
107
Average Physician Daily Net Revenue
$7,500.00
Forfeited Net Revenue During Physician Onboarding
$802,500.00
Retroactive Payer Reimbursement Allowance (CMS,
Medicaid)
20%
Retroactive Payer Reimbursements
($160,500.00)
Total Net Revenue Forfeiture During Onboarding
$642,000.00
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
Billable Days From Recruitment to Enrollment
107
Average Physician Daily Net Revenue
$7,500.00
Forfeited Net Revenue During Physician Onboarding
$802,500.00
Retroactive Payer Reimbursement Allowance (CMS,
Medicaid)
20%
Retroactive Payer Reimbursements
($160,500.00)
Total Net Revenue Forfeiture During Onboarding
$642,000.00
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Metric
Value
Number of Credentialed Physicians
600
Annual Turnover Rate
12%
Annual New Physician Appointments
72
Calendar Days From Recruitment to Enrollment
150
Billable Days From Recruitment to Enrollment
107
Average Physician Daily Net Revenue
$7,500.00
Forfeited Net Revenue During Physician Onboarding
$802,500.00
Retroactive Payer Reimbursement Allowance (CMS,
Medicaid)
20%
Retroactive Payer Reimbursements
($160,500.00)
Total Net Revenue Forfeiture During Onboarding
$642,000.00
Aggregate Annual Forfeited Net Revenue
$46,224,000.00
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Industry-wide Impact
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Reduced Onboarding/Enrollment Cycle Time
Simplified Practitioner Engagement
Significant Reduction in Revenue Forfeitures
Lowered Administrative Costs & Burdens
Recognition of Investments in Time & Effort
Continuous Maintenance & Risk Mitigation
Occupationally Agnostic
Market Objectives
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Complex Data
Inherently Unstructured
No Standards
Unique Attributes
Unlimited Types
Doesn’t “Fit” into Traditional
Databases
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Organizational Context
Wellingud Health SystemWellingud Health System
Rules
🔃 Processes
📝 Requirements
📑 Forms
💾 Data
Established Systems
& Processes
Bylaw & Policy Driven
Aligned with
Operational
Requirements
Unique Interpretation
of Data and Artifacts
Exceptionally
Difficult to Change
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Complex Analytics
Reliant on Individual
Empirical Knowledge & Experience
Complex Rules
Expensive & Inefficient
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Lack of Trust Between Constituents
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Creates Widespread Redundancy
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Simplifying Complexity
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Recognizing Value
Portfolio Artifacts
Delineation of
Privileges
Artifact Verifications
St. Mary’s Hospital
Document
Image
Artifact
Metadata
Verification
Verification Details
Verification Resource
Verification Method
Verification Outcome
Asset Stake
Verification Details
Verification Resource
Verification Method
Verification Outcome
Asset Stake
Eastside Hospital
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Open Source vs. .Net
Transaction Payloads & Data
Management
DLT Protocol Performance
UX & Device Considerations
API Connectivity
HIPAA / HITECH
Bottom Line:
Current
Relevant
Massively Scalable
Compliant & Secure
Architectural Considerations
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Confirms the origin, data, and history of an asset
with exceptionally high reliability
Moves trust to the software and disambiguates
centralized control of information
Maturing into purpose-built, enterprise level
solutions
Generation 1 -- BitCoin
Generation 2 Ethereum, Hyperledger et al.
Generation 3 R3/Corda, Digital Asset
Practitioner identity and credentialing represent
an ideal early adoption use case for the industry
Why Blockchain / DLT?
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Privacy
Security
Performance
Tokenization vs. Fiat Currency Transactions
Consensus Algorithms & Deployment Realities
DLT Considerations
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Digital Asset’s DAML Protocol
Permissioned
Confidential
Industry-level Performance
Massively Scalable
Developed Specifically for
Markets and Exchanges
Simplified Smart Contract
Development
Protocol & Use Case Alignment
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Success = Model Convergence
Business Model
Technical Model
Network
Governance
Model
Finding this is hard
(but your future may depend on it)
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Participants
Delivery Members
Payer Members
Consolidate
management of
credentials with
business partners
Reduce administrative
costs and burdens
Align business partners
with portfolio changes
Enhance mobility and
reach with new
business partners
Increase revenue by
reducing onboarding
cycle time
Reduce cost and
complexity
Improve practitioner
engagement
Simplify recredentialing
and reappointment
processes
Maintain perpetual
alignment with
practitioner data
Substantially reduce
costs associated with
provider data
management
Simplify enrollment and
reenrollment cycle
times
Maintain perpetual
alignment with
practitioner data
Reduce fines
associated with
directory data
misalignment
Incentive Alignment
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Markets Must Emerge With Significant Supply of Data and
Verification Assets
Significant Scale Achieved Through:
Recruitment of National Payers and Super-Regional
Healthcare Firms
Integration With Existing Data Aggregators & Software Firms
Developing Implementation Partners to Drive Scalability
Creating Financial Incentives For Early Adoption
Member Diversity
Minimized Disruption of Existing Business Processes
Create Incentives for Collaboration in Light of Competition
Creating a Minimum Viable Network
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Ideate with Key Market Influencers to Ensure Market/Product Fit
Most Solutions Require Significant Networks and Diverse
Participation to Align Members
Build Early Prototypes to Visualize Value Proposition & Engender
Support
Balance Architectural Ideals with Real-World Deployment
Realities
Create Governance Models Led By Network Members
Involve Network Members In All Phases of Solution Development,
Testing, Piloting, & Commercial Deployment
Create Realistic Capital Requirements & Target Strategic Sources
Deployment Best Practices
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Questions
Anthony D. Begando
CEO
678
-575-4495
abegando@procredex.com
@
AnthonyBegando
https://
www.linkedin.com/in/adbegando/